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Advantage Dental Oral Health and Vision Center of Alabama, P.C.

Details

Name: Advantage Dental Oral Health and Vision Center of Alabama, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 15 Sep 2003 (21 years ago)
Entity Number: 000-558-790
Register Number: 000558790
Historical Names: Calhoun County Dental Center, Inc.
Sarrell Regional Dental Center for Public Health
Sarrell Regional Dental Center for Public Health, Inc.
County: Calhoun
Place of Formation: Calhoun County
Principal Mailing Address: 3322 WEST END AVE. SUITE 400NASHVILLE, TN 37203
Principal Address: 702 S. QUINTARD AVE.ANNISTON, AL 36201
Principal Address ZIP Code: 36201
Registered Office Street Address: 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104
Registered Office Street Address ZIP Code: 36104
Authorized Capital: 1000

Activities RENDERING PROFESSIONAL DENTAL AND OPTOMETRIC SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1801372958 2018-07-12 2022-01-04 3322 W END AVE STE 400, NASHVILLE, TN, 372036805, US 3439 B MCGEHEE ROAD, SUITE 22, MONTGOMERY, AL, 361113392, US

Contacts
Phone +1 629-999-5014
Phone +1 334-284-0228
Fax 3342881825

Authorized person
Name SHERRIE EDMONDSON
Role MANAGER, LICENSING & CREDENTIALING
Phone 6299995014

Taxonomy
Taxonomy Code 152W00000X - Optometrist
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529932849
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BLUE CROSS AND BLUE SHIELD OF ALABAMA 2017 200232609 2019-02-08 SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH 109
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2017-08-01
Business code 621210
Sponsor’s telephone number 6299995022
Plan sponsor’s mailing address 230 E 10TH ST, ANNISTON, AL, 362075784
Plan sponsor’s address 230 E 10TH ST, ANNISTON, AL, 362075784

Number of participants as of the end of the plan year
Active participants 138
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2019-02-08
Name of individual signing TERESA HAMMETT
Valid signature Filed with authorized/valid electronic signature
PRUDENTIAL INSURANCE 2017 200232609 2019-02-08 SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH 116
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2017-09-01
Business code 621210
Sponsor’s telephone number 6299995022
Plan sponsor’s mailing address 230 E 10TH ST STE 106, ANNISTON, AL, 362075771
Plan sponsor’s address 230 E 10TH STREET STE 106, ANNISTON, AL, 36207

Number of participants as of the end of the plan year
Active participants 116
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2019-02-08
Name of individual signing TERESA HAMMETT
Valid signature Filed with authorized/valid electronic signature
PRUDENTIAL INSURANCE 2016 200232609 2018-03-13 SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH 170
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2016-09-01
Business code 621210
Sponsor’s telephone number 2562417277
Plan sponsor’s mailing address 230 E 10TH ST STE 106, ANNISTON, AL, 362075771
Plan sponsor’s address 230 E 10TH ST STE 106, ANNISTON, AL, 362075771

Number of participants as of the end of the plan year
Active participants 170
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2018-03-13
Name of individual signing TERESA HAMMETT
Valid signature Filed with authorized/valid electronic signature
BLUE CROSS BLUE SHIELD OF ALABAMA 2016 200232609 2018-02-20 SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH 109
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2016-08-01
Business code 621210
Sponsor’s telephone number 2562417277
Plan sponsor’s mailing address 230 E 10TH ST, ANNISTON, AL, 362075784
Plan sponsor’s address 230 E 10TH ST, ANNISTON, AL, 362075784

Number of participants as of the end of the plan year
Active participants 179
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2018-02-20
Name of individual signing TERESA HAMMETT
Valid signature Filed with authorized/valid electronic signature
SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH RETIREMENT PLAN 2014 200232609 2015-04-23 SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH 99
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 2567417340
Plan sponsor’s address 230 EAST 10TH STREET, SUITE 106, ANNISTON, AL, 36207

Plan administrator’s name and address
Administrator’s EIN 721386027
Plan administrator’s name PLANTECH, LLP
Plan administrator’s address 2205 CAHABA VALLEY DR, BIRMINGHAM, AL, 35242
Administrator’s telephone number 2059801603

Signature of
Role Plan administrator
Date 2015-04-23
Name of individual signing KATHY BITTLE
SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH RETIREMENT PLAN 2013 200232609 2014-10-14 SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH 117
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 2567417340
Plan sponsor’s address 230 EAST 10TH STREET, SUITE 106, ANNISTON, AL, 36207

Plan administrator’s name and address
Administrator’s EIN 721386027
Plan administrator’s name PLANTECH, LLP
Plan administrator’s address 2205 CAHABA VALLEY DR, BIRMINGHAM, AL, 35242
Administrator’s telephone number 2059801603

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing KATHY BITTLE
SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH RETIREMENT PLAN 2012 200232609 2013-09-09 SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH 102
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 2567417340
Plan sponsor’s address 230 EAST 10TH STREET, SUITE 106, ANNISTON, AL, 36207

Plan administrator’s name and address
Administrator’s EIN 721386037
Plan administrator’s name PLANTECH, LLP
Plan administrator’s address 2205 CAHABA VALLEY DR, BIRMINGHAM, AL, 35242
Administrator’s telephone number 2059801603

Signature of
Role Plan administrator
Date 2013-09-09
Name of individual signing JASON DAVIS
SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH RETIREMENT PLAN 2011 200232609 2012-09-11 SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH 62
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 2567417340
Plan sponsor’s address 230 EAST 10TH STREET, SUITE 106, ANNISTON, AL, 36207

Plan administrator’s name and address
Administrator’s EIN 200232609
Plan administrator’s name SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH
Plan administrator’s address 230 EAST 10TH STREET, SUITE 106, ANNISTON, AL, 36207
Administrator’s telephone number 2567417340

Signature of
Role Plan administrator
Date 2012-09-11
Name of individual signing KATHY BITTLE
SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH RETIREMENT PLAN 2010 200232609 2011-08-12 SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 2567417340
Plan sponsor’s address 230 EAST 10TH STREET, SUITE 106, ANNISTON, AL, 36207

Plan administrator’s name and address
Administrator’s EIN 200232609
Plan administrator’s name SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH
Plan administrator’s address 230 EAST 10TH STREET, SUITE 106, ANNISTON, AL, 36207
Administrator’s telephone number 2567417340

Signature of
Role Plan administrator
Date 2011-08-12
Name of individual signing BURT ARTHUR
SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH RETIREMENT PLAN 2009 200232609 2010-10-06 SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 2567417340
Plan sponsor’s address 230 EAST 10TH STREET, SUITE 106, ANNISTON, AL, 36207

Plan administrator’s name and address
Administrator’s EIN 200232609
Plan administrator’s name SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH
Plan administrator’s address 230 EAST 10TH STREET, SUITE 106, ANNISTON, AL, 36207
Administrator’s telephone number 2567417340

Signature of
Role Plan administrator
Date 2010-10-06
Name of individual signing BURT ARTHUR

Director

Name Role Address
JAMES E. THOMMES, D.D.S. Director No data
CORY B. WHITE, D.M.D. Director 102 CRUZ COURTDOTHAN, AL 36305
JOHN R.CLASEN, JR., O.D. Director No data

Agent

Name Role Address
CORPORATION SERVICE COMPANY INC Agent 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808

Incorporator

Name Role Address
CORY B. WHITE, D.M.D. Incorporator 102 CRUZ COURTDOTHAN, AL 36305
JOHN R. CLASEN, JR. O.D. Incorporator 469 CAHABA LANDINGS ROADIRONDALE, AL 35210

Organizer

Name Role Address
JOHN R. CLASEN, JR. O.D. Organizer 469 CAHABA LANDINGS ROADIRONDALE, AL 35210
CORY B. WHITE, D.M.D. Organizer 102 CRUZ COURTDOTHAN, AL 36305

Events

Event Date Event Type Old Value New Value
2021-12-27 Name Change Sarrell Regional Dental Center for Public Health, Inc. Advantage Dental Oral Health and Vision Center of Alabama, P.C.
2006-09-14 Name Change Sarrell Regional Dental Center for Public Health Sarrell Regional Dental Center for Public Health, Inc.
2005-05-03 Name Change Calhoun County Dental Center, Inc. Sarrell Regional Dental Center for Public Health

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Related by address

641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104

DIVISION 7 CONSTRUCTION, INC. The Advertiser Company Alabama Farmers Cooperative, Inc. Whitfield Foods, Inc. Westfield Services, Inc. Lucia Securities, LLC Southcoast Paper Products, LLC 24 On Physicians, PC Pine Bluff Materials Co. LLC Wells Fargo Commodities, LLC

Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State

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